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On World Hepatitis Day, Watch for Complications With HIV

by Winnie McCroy

EDGE Editor

Monday July 28, 2014

In 2008, the World Health Organization declared July 28 as World Hepatitis Day, one of only four official disease-specific health observances. Out of the almost 150 million people who have chronic hepatitis C infection, 300,000 to 500,000 people will die this year. Doctors are working hard to provide better access to hepatitis C treatment, especially for those living with HIV.?

"Studies of individuals who have both HIV and hepatitis C in the U.S. and Europe have shown that they have higher rates of liver failure and death than those with HIV or hepatitis C alone," said amfAR VP and Director of TREAT Asia, Dr. Annette Sohn. "We are now starting to gather data on this issue in resource-limited settings, but there are serious implications for millions of people living with HIV."

Four hundred million people around the globe are living with viral hepatitis, a liver disease usually spread through contact with an infected person's blood. It can lead to severe liver damage, cancer and even death.

Hepatitis C is the most chronic form of the disease and is the leading cause of cirrhosis and liver cancer. Every year it kills about 15,000 of the more than four million people who have it in the United States alone. Liver disease is a growing public health challenge. With the introduction of a new treatment, Hepatitis C has been making headlines and stands to be propelled to the center of the nation's ongoing healthcare debate. It shows how new oral drug combinations are curing more of the hardest-to-treat Hepatitis C patients.

The latest treatment shows a promising 90 percent cure rate, but its controversial price tag makes it one of the most expensive prescription drug treatments in our nation's history. World Hepatitis Day is the perfect opportunity to pay careful attention to this debate, along with new treatments ahead that could have an impact on lowering costs.

Individual doctors and state health programs are working on ways to make treatment more affordable. Some action is also taking place on a federal level in Congress, questioning treatment cost and access.

On July 27, The Lancet reported that two new pill-only antiviral drug regimens could provide shorter, more effective treatment options with fewer side effects for the majority of patients infected with hepatitis C.

In the HALLMARK-DUAL phase 3 study, Professor Michael Manns from Hannover Medical School in Germany and colleagues randomly assigned 645 patients with HCV genotype 1b from 18 countries to receive a 6-month course of treatment with a pair of oral DAAs asunaprevir and daclatasvir. The regimen was highly effective at clearing the virus and well-tolerated even in patients who have traditionally been the hardest to treat.

Ninety percent of previously untreated patients and 82 percent who were intolerant of, or who had been treated unsuccessfully using standard regimens, were cured.

"The efficacy and safety of 24 weeks of daclatasvir plus asunaprevir represent a huge improvement on the first generation of protease inhibitor-based triple therapies for HCV genotype 1b infection (up to 48 weeks of boceprevir or telaprevir in combination with PEG/RBV)," said Manns. "This new all-oral interferon and ribavirin-free combination could provide a more effective, safer, shorter and simpler treatment option for those traditionally hard-to-cure patients with cirrhosis or those who have failed to respond to existing therapies."

These findings could make a big impact in Asia, where hepatitis and HIV are hitting hard. The WHO Western Pacific Region bears a disproportionally high burden of hepatitis in comparison to worldwide figures: although it is home to about quarter of the world's population, it accounts for about 50 percent of hepatitis B infections worldwide.

And of the 130-150 million people worldwide who are chronically infected with hepatitis C, more than 60 million live in the Western Pacific Region. The Western Pacific Region accounts for more than 60 percent of global liver cancer cases, the majority of which are caused by chronic hepatitis B or C.

"The Asia-Pacific has the highest burden of hepatitis and the second highest burden of HIV worldwide," said Sohn. "These dual epidemics must be addressed through education and hepatitis treatment. Without immediate action from governments and pharmaceutical companies, our recent progress in expanding treatment for HIV will only be followed by an increase in global deaths from liver disease."

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Winnie McCroy is the Women on the EDGE Editor, HIV/Health Editor, and Assistant Entertainment Editor for EDGE Media Network, handling all women's news, HIV health stories and theater reviews throughout the U.S. She has contributed to other publications, including The Village Voice, Gay City News, Chelsea Now and The Advocate, and lives in Brooklyn, New York.